Lecture Series

TEXT OF SPEECH DELIVERED by
GEORGE C. EGO-OSUALA MD
ON THE OCCASION OF AFRICA AIDS AWARENESS
ON NOVEMBER 30TH 2001, CHEVERLY MARYLAND, USA.

It is a pleasure for me to be invited to speak on this occasion and I thank all of you for coming to listen to this speech.

It has been quite some time since I gave a speech of this nature. All this while I have enjoyed listening to people. I will begin by telling the story of a man who got up to the podium to make a speech this being something he did not like very much, and all he said was "Ladies and Gentlemen, you know it all either individually and collectively and I feel I will be spending your time by going over the whole talk, Thank you," and he proceeded to sit down.

I do not intend to do that this evening because what I will be speaking about is an important issue that requires action.

Today as I stand here and looking at the audience I find that I can identify specific faces, I can attach specific names to some specific faces, but here this evening, I will be speaking about a medical condition which has no face yet it has a specific name. This medical condition is HIV Disease and AIDS.

I will illustrate the Facelessness of HIV disease with an experience I had at Woodhull Hospital which happens to be an AIDS designated Hospital with this well dressed executive who walked up to have a pre-life insurance physical examination. I did not feel this executive was a candidate for testing so I skipped this option. He however requested HIV testing and this was done and to my dismay he turned out positive for the HIV virus. On the contrary I had this other unkempt patient, an alcoholic who was tested, but he turned out negative for the virus.

The message I am trying to send across here is that HIV Disease is "Faceless," it is a catacomb of symptomatology and diseases caused by a virus.
The sentinel cases of AID/HIV were reported in June 1981. By 1982 the syndrome was beginning to be identified with certain "high risk" group the 4H's - heroin addicts, hemophiliacs, the homosexuals and the Haitians. As the epidemiology gradually unfolded it became clear that a virus caused AIDS and HIV disease. In 1983 the HIV virus was identified in 1985 the blood test that could identify the HIV infected individual prior to the development of AIDS was developed.
I will be quick to add the HIV infection does not mean AIDS.

The first cases were reported in Los Angeles followed by over 20 cases in New York. Extensive retrospective studies revealed several cases diagnosed in 1978 and 1979 with other cases which may have been discovered or diagnosed in Europe, the USA and Africa as much as three decades prior.

In the late part of the 80's information regarding the natural history of the disease and the common manifestation of HIV related disorder and clinical experience in caring for HIV infected persons began to grow to the exponential growth of the epidemic itself.

Since the first cases of AIDS were reported in 1981, infection with the HIV has become a global medical crises more so in Sub Saharan Africa.

Reports from WHO reveal that in July 1990 no case was reported from 2 countries in Africa while 51countries reported one or more cases. There was a total of 66,978 cases reported. In the Americas, no country or territory reported no case while 44 countries or territories reported one or more cases and the number of cases reported was 167,014. The total number of cases reported in five continents consisting the Americas, Africa, Europe, Asia and the Oceania was 273,425, but by 1999 the number had risen to 34.3 million. Of this total 24.5 million came from Africa. The number is estimated at 36.14 at the end of the year 2000.

Africa is thus home to 70% of the adults and 80% of the children living with HIV in the world. AIDS totaled 3 million deaths globally in 2000 and of the global total, 2.4 million AIDS deaths occurred in Africa. This supports the report that in Sub Saharan Africa HIV is deadlier than was itself. In 1998, 200,000 Africans died in wars, but more than two million died of AIDS. The number rose to 2.4 in 2000. By way of available statistics at the end of 1999; the following countries had the following number of reported HIV or AIDS cases (for people 15 years to 49) and he corresponding deaths for adults and children.

Angola 150,000 15000
Cameron 520000 52000
Ivory Coast 730000 72000
Eq. Guinea 1000 120
Eritrea & Ethiopia 2.9m 280,000
Ghana 330000 3300
Nigeria 2.6m 250000
South Africa 4.1m 250,000
Mauritius 0 500

Sixteen Sub Saharan African countries have more than 10% of the adult population (15 years- 49) infected with HIV. In seven countries in the Southern cone; one adult in five is living with the virus.

Cote d'Ivoire is already among the 15 worst affected countries in the world.
In Botswana 35.8% of adults are now infected. In South Africa 19.9% are infected and with a population of 4.2 million infected people, South Africa has the largest number of people living with HIV/AIDS in the world.

The numbers in Ethiopia and Kenya are pathetic and continue to rise.
"Charity they say begins at home" I will like to talk about the situation in my home country Nigeria which is the giant of Africa and the most populous country in Sub Saharan Africa; 5% of it's adult population is infected. In Nigeria, the prevalence rate among sexually active (15-49) has been on the increase since the first national survey in 1991, which showed a prevalence rate of 1.8%, this rose to 3.4% in 1993; 4.5% in 1995 and 5.4% in 1999 equivalent to 2.6m. This figure constituted even 10% of the African HIV/AIDS burden. It is disturbing to note that this growing incidence is more in the younger age groups of (20-24) years. It is in this group that the peak prevalence of 8.1% occurred.

From the fore going it is evident that Africa needs to check this scourge of HIV/AIDS on its people. In the words of Nelson Mandela at the Durban 2000 AIDS conference in South Africa "Let us not equivocate a tragedy of unprecedented proportion is unfolding in Africa." It has already gripped 13.92 million women of child bearing age and since the culture of Africa is to have large families, the geometrical increase in the number of infected children and subsequently orphans increases the call for action and for help.

HIV/AIDS has now been upgraded from terminal disease status to chronic disease status, but regrettably this is in the developed world, but not in Africa where it is still worse than war itself.

It is certain therefore that Africa needs help to control this epidemic and eventually upgrading it to a chronic disease status. Control of this epidemic will call for a thorough education aimed at informing people about methods of spread, encourage the infected to present themselves for treatment, making testing station available, cessation of stigmatization of the infected and sexual education and improvement in the economic status. It also needs commitment of the governments to this cause and sharing of knowledge in the world of academia.

The main ways by which someone can become infected with HIV are
1). Unprotected penetrative sexual, intercourse with someone who is infected,
2) Injection or transfusion of contaminated blood products, donation of semen, skin grafts and organ transplants from someone who is infected.
3. from a mother who is infected to her baby; this may be during the course of pregnancy, at birth and through breast feeding,
4. Sharing unsterilised injection equipment that has been previously used by someone who is infected.
5. It is important to note the recurring clause here is "who is infected." The need to identify infected people and the need for testing stations cannot be overemphasized People should be encouraged to come up for testing. Testing stations without people to test does not serve the purpose.

. The only way to know who is infected is by people getting tested.
Testing straight away after any suspicious exposure does not yield any reliable results. Antibodies to HIV take about 3 months to develop with 98% seroconversion having occurred within 6 months of infection.

Unfortunately, testing has been difficult in Sub Saharan African. This is because of the stigmatization associated with HIV infection, which is seen as a punishment for sexual promiscuity, and for other vices, which are regarded as abominable. Infected persons are rejected and ostracized by their families. People with or suspected of having HIV may be turned away from healthcare services, employment, refused entry into foreign countries and even denied justice.
Fear of discrimination keeps people away from getting tested. The invisibility of PLWHA drives the epidemic underground. The level of stigmatization was well elucidated by the presentation of Mohamed Farouk a PLWHA at the Abuja summit. He says, "In spite of the duration of the epidemic and the emerging scientific advancements, there is still an enormous level of stigmatization and ruthless discrimination. Even the young are not spared"

In December 1998, Gugu Dhlamini was stoned and beaten to death by neighbors in her township near Durban, South Africa after speaking out openly in world AIDS Day about her HIV status. Actions like the foregoing have been reported in Ethiopia.

The trend here is fear of discrimination begets silence by the infected person who goes in to live a "normal" sexual life and the epidemic continues to flourish..
Having gone so far, the big question remains, Is Africa doomed? What next with the HIV and Africa?

I will like to share with you the vaccine update with the HIV. Some of us have read about the Kemron cure from Kenya, about Prof. Luhurma from Zaire. Recently we are learning about Prof. Abalaka's work in Nigeria; these so far do not look or for some reasons and constraints were made to look acceptable. Some infected persons testified to the Kemron cure. Mohammed Farouk testified to the efficacy of Prof. Abalaka's work at the Abuja summit. Prof. Abalaka however could not scientifically substantiate or explain all he did. Einstein could not explain the Theory of Relativity but it stands true and infallible. The urgency of the discovery of vaccine has resulted into researchers looking into the issues of alternative therapy and other vaccine formulation for viral therapy.

There are viral formulations going on in the US and Thailand. We have the "gp 120" vaccine or the "envelope vaccine," we have the " whole virus vaccine" study, the "Dressed up" vaccine study and the "naked" DNA vaccine study.
It is estimated that it may take about ten years before the world has its first vaccine against HIV and the future looks good. But is it really good for Africa? If the developed work is looking at 10 years, then Africa will be looking at more than 10 years. The big question is what will be left of Africa then if nothing is done now?

What I am saying here is Africa needs help in all forms. Africa needs help from its people, its governments and the world powers and world body. The educated and informed people of Africa will play a role in educating people back home about the basic information of AIDS and HIV, testing centers have to be set up, and a body whose main responsibility is commitment to controlling the scourge of HIV needs to be set up.

Since HIV is already ravaging the nations of Africa, it is time to stop painting HIV as a deadly clothed skeleton. The massage of hope for the infected persons must now be put up. Most importantly the developed world has to rally together and make funds available for the actualization of the machinery to achieve this goal.
Much lip service has been paid to HIV, AIDS and PLWHA in Africa. Africa and AIDS has made enough good reading in medical books. It is time the drugs are made available and affordable for infected persons in Africa. Pregnant, infected women should have access to medications to protect the unborn.

Medications do not come cheap and as long as their cost remains unaffordable and unavailable, AIDS continues to spread in Africa. The poor infected people of Africa will continue to seek solace in the prayer houses in the hope for spiritual healing and the casting out of the "demons" believed to have afflicted this "punishment" on them. The death toll continues to rise and make the statistics and Africa gradually gets to extinction.

Billions of dollars, euro and pound sterling are wasted daily in pursuit and propagation of wars while no funds are directed to stop an enemy more than war to a people. The whole world watches while a people are exterminated. Where is world conscience?

In closing I will call on the civilized world using the words of
Dr. Lester Brown chairman of World Watch Institute who told the civilized world thus " If you fail to respond, you will forfeit the right to call yourselves civilized societies and your chance to save Africa."

And in the words of Mohammed Farouk and I enjoin you " If you respond then you will change A-I-D-S from Acquired Immune Deficiency Syndrome to Africa Is Destined to Survive.